ATI PHARMACOLOGY NSG 1540 EXAM 3
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Free ATI PHARMACOLOGY NSG 1540 EXAM 3 Questions
An adult client is prescribed indomethacin 25 mg PO three times daily for acute gouty arthritis. The nurse is providing education about the medication. Which of the following correctly completes the teaching?
- Indomethacin reduces pain and inflammation by stimulating serotonin production. Before initiating therapy, renal function should be assessed, and the client should monitor for GI complications.
- Indomethacin reduces pain and inflammation by inhibition of prostaglandin synthesis. Before initiating therapy, renal function should be assessed, and the client should monitor for and report any complications promptly.
- Indomethacin reduces pain and inflammation by increasing prostaglandin release. Before initiating therapy, liver function should be assessed, and the client should monitor for bleeding complications.
- Indomethacin reduces pain and inflammation by inhibition of prostaglandin synthesis. Before initiating therapy, blood glucose should be assessed, and the client should monitor for signs of infection.
Explanation
Correct Answer: B) Indomethacin reduces pain and inflammation by inhibition of prostaglandin synthesis. Before initiating therapy, renal function should be assessed, and the client should monitor for and report any complications promptly.
Indomethacin is an NSAID that works by inhibiting prostaglandin synthesis through COX enzyme inhibition, reducing inflammation and pain associated with gout. Renal function must be assessed prior to initiation as NSAIDs can cause nephrotoxicity and are contraindicated in significant renal impairment. The client must be educated to monitor and promptly report GI symptoms such as bleeding or ulceration, which are the most common serious adverse effects of indomethacin.
A nurse is preparing to start chloroquine for malaria prevention. Which client history finding should be reported to the provider before giving the medication?
- Recent travel to a non-endemic area
- Client takes ibuprofen for headaches
- History of renal impairment
- Reports of mild nausea with previous antibiotics
Explanation
Correct Answer: C) History of renal impairment
Chloroquine is primarily eliminated through the kidneys, making renal impairment a significant concern before initiating therapy. In patients with reduced kidney function, chloroquine can accumulate to toxic levels in the blood, increasing the risk of serious adverse effects including retinal toxicity, cardiac arrhythmias, and neurotoxicity. This finding must be reported to the provider so that the dose can be adjusted or an alternative antimalarial selected to ensure safe administration.
Recent travel to a non-endemic area does not affect the safety of chloroquine and is not a reportable concern. Ibuprofen use for occasional headaches is generally not a contraindication to chloroquine. Mild nausea with previous antibiotics is a common, minor GI complaint unrelated to chloroquine therapy and does not require provider notification before starting the medication.
A nurse is assessing a client with a suspected fungal infection. Which cue would indicate the need for a topical antifungal treatment?
- Linear, burrow-like tracks on the skin
- Presence of red, raised, circular rash with clear center
- Small, fluid-filled vesicles clustered in a patch
- Yellow, pus-filled blisters on the skin
Explanation
Correct Answer: B) Presence of red, raised, circular rash with clear center
A red, raised, circular rash with a clear center is the classic presentation of tinea corporis — commonly known as ringworm — a superficial dermatophyte fungal infection of the skin. Despite its name, it is caused by a fungus, not a worm, and is characterized by its distinctive ring-like appearance with an advancing scaly border and central clearing. This presentation directly indicates the need for topical antifungal therapy such as clotrimazole or terbinafine.
Linear, burrow-like tracks on the skin are the hallmark of scabies — a parasitic infestation caused by Sarcoptes scabiei — requiring antiparasitic treatment, not antifungals. Small, clustered fluid-filled vesicles suggest a viral infection such as herpes simplex or varicella, requiring antiviral therapy. Yellow, pus-filled blisters indicate a bacterial infection such as impetigo, which requires antibiotic treatment.
A nurse is preparing to administer penicillin G to a client. The client reports a history of a rash after receiving amoxicillin. Which action should the nurse take?
- Ask the client to describe the rash and proceed if it was mild
- Administer the medication and monitor for a reaction
- Document the allergy and give the medication with diphenhydramine
- Notify the provider before administering the medication
Explanation
Correct Answer: D) Notify the provider before administering the medication
Amoxicillin is a penicillin-class antibiotic, and a reported rash following its use may indicate a penicillin allergy. Since penicillin G belongs to the same beta-lactam antibiotic class, cross-reactivity is a significant concern. Before administering any medication from the same drug class to a client with a possible allergic history, the nurse must notify the provider to evaluate the allergy, determine its severity, and decide whether to proceed, substitute an alternative antibiotic, or conduct allergy testing. Patient safety takes priority over proceeding with administration.
Asking about the rash and proceeding based on severity bypasses the required provider consultation and places the patient at risk. Administering the medication and monitoring is unsafe given the potential for cross-reactive anaphylaxis. Giving diphenhydramine prophylactically does not adequately protect against a severe allergic reaction and is not an appropriate independent nursing action in this situation.
A nurse is caring for a client who is receiving amoxicillin IV for an infection. The client develops hives and complains of itching. What should the nurse's next action be?
- Stop the amoxicillin immediately and assess the client's airway, breathing, and circulation
- Administer a dose of diphenhydramine to alleviate the rash
- Notify the healthcare provider to discuss alternative antibiotics for the client
- Instruct the client to continue the amoxicillin but monitor the client closely for any further reactions
Explanation
Correct Answer: A) Stop the amoxicillin immediately and assess the client's airway, breathing, and circulation
Hives and itching during IV antibiotic administration are signs of an allergic reaction that can rapidly progress to anaphylaxis — a life-threatening emergency involving airway compromise, bronchospasm, and cardiovascular collapse. The nurse's immediate priority following the ABC (Airway, Breathing, Circulation) framework is to stop the infusion at once to prevent further allergen exposure, then rapidly assess for signs of anaphylaxis such as stridor, hypotension, or angioedema.
Administering diphenhydramine and notifying the provider are appropriate subsequent steps but only after stopping the medication and completing the primary assessment. Continuing the amoxicillin would be a dangerous error, as the allergic reaction could escalate to a fatal anaphylactic response with continued exposure.
A nurse is teaching a client who is starting to take methotrexate to treat rheumatoid arthritis. Which of the following instructions should the nurse include in the teaching?
- "Drink at least 2 liters of water daily."
- "Take the medication daily."
- "Avoid eating foods high in vitamin K."
- "Use an alcohol-based mouthwash after each meal."
Explanation
Correct Answer: A) "Drink at least 2 liters of water daily."
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that can be nephrotoxic and may cause precipitation of drug crystals in the renal tubules. Adequate hydration of at least 2 liters of water daily helps maintain renal perfusion, promotes excretion of the drug and its metabolites, and reduces the risk of kidney damage and toxicity. Hydration is therefore a key safety instruction for patients on methotrexate therapy.
Methotrexate for rheumatoid arthritis is taken weekly — not daily — as daily dosing significantly increases the risk of severe toxicity including bone marrow suppression and hepatotoxicity. Avoiding foods high in vitamin K is relevant for patients on warfarin, not methotrexate. Alcohol-based mouthwash should be avoided because methotrexate already carries hepatotoxic risk, and alcohol compounds liver damage while also irritating oral mucosa — patients should instead use a gentle, non-alcoholic rinse, especially given that mucositis is a known side effect.
A nurse is teaching a client who has a new prescription for colchicine to treat gout. Which of the following instructions should the nurse include?
- "Increase your intake of grapefruit juice."
- "Expect to have increased bruising."
- "Take this medication with food if nausea develops."
- "Monitor for muscle pain."
Explanation
Correct Answer: D) "Monitor for muscle pain."
Colchicine can cause myopathy and rhabdomyolysis, making it essential for clients to monitor and report muscle pain, weakness, or tenderness promptly. Grapefruit juice inhibits the metabolism of colchicine, increasing the risk of toxicity and should be avoided. Increased bruising is not a common or expected side effect of colchicine. While GI upset is common, the standard recommendation is to take colchicine with water and not specifically with food as a primary instruction.
A nurse is educating a client about antiretroviral medications. Which action should the nurse take to prevent potential drug interactions?
- Recommend the client take the antiretroviral medication on an empty stomach to enhance efficacy.
- Suggest the client mix the antiretroviral medication with alcohol for better absorption.
- Encourage the client to take the antiretroviral medication with grapefruit juice.
- Advise the client to inform the healthcare provider about all current medications, including over-the-counter and herbal supplements.
Explanation
Correct Answer: D) Advise the client to inform the healthcare provider about all current medications, including over-the-counter and herbal supplements.
Many antiretroviral medications have significant interactions with other drugs, including OTC medications and herbal supplements such as St. John's Wort. Ensuring the healthcare provider has a complete medication list allows for review and prevention of harmful interactions. Taking medications on an empty stomach, with alcohol, or with grapefruit juice are all potentially harmful practices that can alter drug absorption, metabolism, and efficacy.
A nurse is teaching a client about the purpose of checking vaccine titers. Which client statement indicates an understanding of the teaching?
- "A titer tells the provider whether I am currently contagious with a disease."
- "A titer determines exactly how much vaccine I should get for a booster."
- "A titer is only needed when someone has an allergic reaction to vaccines."
- "A titer will show if my body did not respond to a vaccine and I need it again."
Explanation
Correct Answer: D) "A titer will show if my body did not respond to a vaccine and I need it again."
A vaccine titer is a blood test that measures the level of antibodies in the blood to determine whether a person has developed adequate immunity following vaccination. If the titer is low or negative, it indicates the body did not mount a sufficient immune response and revaccination may be needed. A titer does not indicate current contagiousness, determine exact booster doses, nor is it reserved only for allergic reactions to vaccines.
A nurse is reviewing the chart of a postoperative client who has been prescribed ketorolac for pain management. Which of the following findings would require the nurse to question the continued use of ketorolac?
- The client reports mild nausea after receiving the medication
- The client has been receiving ketorolac for the past 6 days
- The client reports mild edema in the lower extremities
- The client states their pain level decreased from 8/10 to 4/10 after the dose
Explanation
Correct Answer: B) The client has been receiving ketorolac for the past 6 days
Ketorolac is a potent NSAID indicated for short-term pain management only, with a maximum recommended duration of 5 days in adults. Exceeding this limit significantly increases the risk of serious adverse effects including gastrointestinal bleeding, peptic ulceration, and renal toxicity due to prolonged prostaglandin inhibition. At 6 days, the nurse must question the order and notify the provider, as continued use beyond the recommended timeframe is unsafe and warrants reassessment of the pain management plan.
Mild nausea is a common, manageable side effect that does not require discontinuation. Mild lower extremity edema should be monitored but is not an immediate indication to stop the medication. A decrease in pain score confirms therapeutic effectiveness and supports continued appropriate use within the safe timeframe.
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